A Survey of Māori Medical Graduates from Te Whare Wanānga o Otago

Lauren BarnettAssociate Professor Joanne Baxter

Presentation

• Aims• Hypothesis• Methods• Response• Results• Conclusions• Experience of BMedSci year

Aims• Where are Māori Medical graduates from The University of Otago

currently working and what is their current level and range of involvement in Māori health?

• What are Māori doctors’ perceptions of expectations made of them, in Māori health?

• What are Māori doctors’ perceptions of their experience of Medical school while they were a student, including experience of support provided and knowledge gained?

• How do Māori doctors perceive the support they receive in their professional training (once qualified), colleges and their current place of work?

• What skills and attributes are important for their practice as a Māori doctor?

Hypothesis• Many Māori doctors will have roles in Māori health – these will be

diverse in number and in kinds of roles.• Junior doctors will have less opportunity to participate in Māori health

than Senior doctors.• Māori doctors will report high levels of expectation for expertise and

knowledge in Māori health.• Māori doctors will have a range of perceptions of medical school with a

diversity reflecting differing time periods since graduation.• Māori doctors will also have a range of perceptions, some positive and

some less positive with regards to the support and understanding of their training programmes, colleges and workplaces.

• Māori doctors will reinforce the importance of knowledge about Māori health and competency both clinically and culturally.

Methods

• Kaupapa Māori research • Survey Monkey

- Internet based survey- Posted Survey

• Survey Questions- Single answer questions- Multiple option questions- Likert scales – for those where an opinion or preference was required.- Commentary boxes

Response

• 77 Responses• 70 completing the questionnaire fully for

analysis • 53.4% response rate for the internet survey • 19.4% response rate for the postal Survey• Limitations

Results (1)

• Socio-demographic profile• Career profile• Time and roles in Māori health – Main

workplace settings• Roles in Māori health – other• Number of roles in Māori health Junior Vs.

Senior doctor

Socio-demographic profile• Similar Numbers of Male and female.• Broad spread of ages from 20-25 up to 60+ years of age. • The largest group were those aged 30-39 years, with

42.9%. • Relative young age of Māori doctors in this survey with

67.1% 39 years and younger.• Broad spread of doctors from Northland to Southland.• Highest numbers Auckland and Capital and Coast (14.3%),

then Canterbury, Mid-Central and Waikato (8.6%).

Career profile- stage of career

Career profile- Area of Practice

Career Profile- Hours worked

Career Profile- Work setting

Time and roles in Māori health

Roles in Māori health – other

- These include advisory in;- Teaching- Mentoring - Supervision - Public health- Community - Leadership, representation - Government, DHB and PHO

Total number of Roles

Total Roles in Māori Health

• Almost 1 in 3 Māori doctors (30.4%) participated in 5 or more roles within these spheres of Māori health.

• Two thirds of respondents (66.7%) were involved in one or more role associated with Māori health

• The mean number or roles was 3 and the median was 2.

Roles in Māori Health Senior vs. Junior

Results (2)

• Expectations of being a Māori doctor• Perspectives on training as a qualified doctor• Perspectives on their time at medical school

(Otago)• Views on the attributes required of Māori

doctors

Expectations of being a Māori doctor

Expectations – Qualitative

• Identity• “One of the major issues is I am not easily

identified as a Māori doctor, which creates barriers in and of itself, especially being in a position of authority within the DHB, and being raised in a Pakeha household. My colleauges (becuase I identify as Māori) expect me to have an indepth cultural knowledge which was not avaialble to me as a younger man”.

Expectations – Qualitative • Excessive expectation• “The expectations at times can be excessive, not only feeling

you have to prove yourself a competent medical professional and particularly so because you are Māori ( still being told you are only a doctor because you are Māori and got in on the Māori scheme). And also the expectations from Whanau/hapu/iwi can be daunting and often feel burnt out. - Whanau/hapu/iwi do not work in the clinical world and often do not understand the logistics or reality of working as a junior doctor in a western medical environment and what you can and cannot do relative to your position”.

Perspectives on training as a qualified doctor

Training Perspectives – Qualitative

• Varying support• “ The variation in workplace settings influences

the need for workplace as opposed to professional training needs of Māori Doctors”

• “There isn't much emphasis on Māori Health in my training programme. The discrepancies are often stated but there is not a lot of teaching/support on how best to deal with Māori patients and their whanau”.

Training Perspectives – Qualitative

• Challenges • “lose support of Māori Colleagues/community

when you move away from university environment, and other life factors take more priority.”

• “Māori Doctors shuold be supported fully with their training needs with regards to Māori Health and their Cultural needs”.

Medical School

Medical school – Qualitative

• Lack of support• “People like you (Māori) are never going to be

the norm at medical school, so you need to leave your Māori shit at home" Kindly said behind closed doors by the [xx] of the [name] medical school.”

Medical school – Qualitative

• Times have changed• “Since my graduation MIHI (CHCH) has developed

the Hauora Māori curriculum. I have been involved in the delivery of this and assessment. It is a much bigger stronger body of teaching than i received and in hindsight would have prepared me better for working with Māori on graduation. they do a fantastic job in CHCH of preparing Māori and non-Māori medical students for working with Māori patients and their whanau.”

Skills, Experience and Attributes of a Māori Doctor

Skills, Experience and Attributes of a Māori Doctor

Skills, Experience and Attributes –Qualitative

• “Strive to be a great doctor first, a great Māori doctor second. Lead by your example of clinical competence”

• “- To enjoy what we do - Revisit the goals we are aiming to achieve, that is reduce disparity of health between Māori and non-Māori and improve the journey for Māori patients through the heath care system. - Be a role model for other young Māori”

Conclusion

• Where are Māori Medical graduates from The University of Otago currently working and what is their current level and range of involvement in Māori health?

• Wide Range of ages, specialties, DHB’s• Those that have the opportunity (senior

doctors) have a number of roles in Māori Health

Conclusion

• What are Māori doctors’ perceptions of expectations made of them, in Māori health?

• Mixed response• Some believe that expectations on a Māori

doctor are disproportionate to other ethnicities

• The people expectations come from vary from other colleagues, whānau and themselves

Conclusion

• What are Māori doctors’ perceptions of their experience of Medical school while they were a student, including experience of support provided and knowledge gained?

Conclusions

• How do Māori doctors perceive the support they receive in their professional training (once qualified), colleges and their current place of work?

• Mixed• Some Colleges are very good, others need to

seriously look into their training supports for Māori doctors and there curriculum on Māori health

Conclusions

• What skills and attributes are important for their practice as a Māori doctor?

• Being an excellent clinician• Competent in Tikanga• Broad knowledge of issues

BMedSci

• 12 months (propberly more)• Gain a lot of new skills• Collaborative process (choose your supervisor

wisely)• Make sure it is something you are passionate

about• Sets you up well in terms of learning about

research